Look­ing back 10 years: At­tract­ing the best and the bright­est

Few sec­tors of the econ­omy have matched health­care’s im­pact and re­siliency over the past few years. Health­care spend­ing made up 17.8% of the coun­try’s gross do­mes­tic prod­uct in 2015 at $3.2 tril­lion, ac­cord­ing to the CMS.

A large chunk of the coun­try’s job cre­ation has also been within health­care, where the sec­tor since 2007 has added 2.5 mil­lion jobs and has ac­counted for 35% of to­tal job growth, more than any other sin­gle in­dus­try dur­ing that pe­riod, ac­cord­ing to an anal­y­sis posted in a March Health Af­fairs blog.

“Health­care job growth has been very steadily pos­i­tive for many years,” said blog co-au­thor Ani Turner, co-di­rec­tor of the Cen­ter for Sus­tain­able Health Spend­ing at the Al­tarum In­sti­tute.

Turner said health­care man­ages to re­main mostly in­su­lated from the eco­nomic down­turns that sharply af­fect other in­dus­tries in part be­cause of the way it is fi­nanced through pub­lic and pri­vate in­sur­ance pro­grams.

In many ways, health­care job growth has been re­spon­si­ble for both re­duc­ing the eco­nomic im­pact of the Great Re­ces­sion and with help­ing to quicken the re­cov­ery. The sec­tor added 600,000 jobs be­tween 2007 and 2010, while the rest of the econ­omy lost 9 mil­lion jobs, ac­cord­ing to Turner. Non­health­care jobs didn’t re­turn to pre-re­ces­sion lev­els un­til Novem­ber 2014. By that time, health­care had added 1.7 mil­lion jobs. And, Turner found, by this past Jan­uary, health­care jobs had jumped 19% over nine years. Some of that growth can be at­trib­uted to in­creased de­mand re­sult­ing from ex­panded health­care cover­age through the Af­ford­able Care Act.

But health­care’s job growth has also been a source of con­tention, es­pe­cially among crit­ics who ar­gue that a per­sis­tent rise in health­care spend­ing pro­motes waste and in­ef­fi­ciency with­out pro­vid­ing in­cen­tives that would sig­nif­i­cantly im­prove health out­comes.

Stem­ming the ris­ing cost of health­care has been one of the forces driv­ing Repub­li­can law­mak­ers to re­peal and re­place the ACA. But crit­ics of re­peal ef­forts have ar­gued that such ac­tions would have re­sulted in the loss of many thou­sands of jobs.

What­ever the reg­u­la­tory out­look for the com­ing years, the de­mand for health­care will con­tinue to rise, which will be a key fac­tor for a mar­ket where the ser­vices of clin­i­cal pro­fes­sion­als such as doc­tors and nurses are pro­jected to be in even shorter sup­ply. An es­ti­mated 82,000 ad­di­tional physi­cians will be needed by 2025 to meet the de­mand, ac­cord­ing to the As­so­ci­a­tion of Amer­i­can Med­i­cal Col­leges.

Health­care’s em­ploy­ment boom though is about more than the sup­ply and de­mand of clin­i­cians. It in­volves the ex­pan­sion of an en­tire in­dus­try due in large part to the ex-

plo­sion of in­for­ma­tion tech­nol­ogy. As has been seen in other in­dus­tries, the dig­i­tal trans­for­ma­tion ex­pe­ri­enced in health­care has opened doors to a whole crop of new work­ers to en­ter a field that was tra­di­tion­ally lim­ited in terms of the va­ri­ety of ca­reer paths it of­fered.

“For years and years, if you went to pre-med, you sort of had two op­tions com­ing out of school—you ei­ther went the ad­min­is­tra­tive route or you could be a clin­i­cian,” said Travis Sin­gle­ton, se­nior vice pres­i­dent at physi­cian staffing firm Mer­ritt Hawkins. “If nei­ther one of those tracks jumped out at you, there re­ally wasn’t a world in be­tween.”

Sin­gle­ton said rapid IT ad­vances have cre­ated a need among health­care providers to de­velop roles that lay out­side of the ad­min­is­tra­tive or clin­i­cal track.

Health­care providers have more re­cently be­gun to use IT as a means of dis­cov­er­ing pa­tients’ needs and wants much like how the re­tail in­dus­try has used such an­a­lyt­ics to de­ter­mine cus­tomer sat­is­fac­tion to im­prove service or prod­ucts. That has spurred hir­ing from other in­dus­tries.

“They’re find­ing that they can teach the health­care part, but the other part that health­care doesn’t teach, that’s what I think is at­tract­ing peo­ple not just to large health sys­tems but to all parts of health­care, and that’s ex­cit­ing,” Sin­gle­ton said.

Be­ware of high turnover

The boom­ing growth in health­care jobs likely also con­trib­utes to an­other is­sue em­ploy­ers have to face: turnover.

Ac­cord­ing to an anal­y­sis con­ducted by Com­p­data Sur­veys, the to­tal av­er­age turnover rate among health­care jobs in 2016 was 19.9%, up from 17.7% in 2014 and 15.6% in 2010. Among other in­dus­tries, the turnover rate in health­care ranks sec­ond to only the hospitality in­dus­try, com­pared to 2010 when it ranked fifth.

While other sec­tors such as hospitality have come to ac­cept high turnover as a part of do­ing busi­ness, it can have a much greater im­pact on a hos­pi­tal or health sys­tem, where los­ing skilled pro­fes­sion­als in an in­creas­ingly com­pet­i­tive job mar­ket can hurt qual­ity and pa­tient safety.

A 2016 re­port on the eco­nomic im­pact of nurse turnover by re­cruit­ing firm NSI

Nurs­ing So­lu­tions es­ti­mated that los­ing a sin­gle nurse can cost a hos­pi­tal be­tween $37,700 to $58,400. The av­er­age hos­pi­tal will lose $5.2 mil­lion to $8.1 mil­lion every year due to nurse turnover.

De­spite the num­bers, many providers still strug­gle with how to ad­dress turnover. “That is a new thing for health­care be­cause they have not had to worry about it to the level they do now,” Sin­gle­ton said. Among clin­i­cians, health­care’s ex­pan­sion has cre­ated an ar­ray of em­ploy­ment op­por­tu­ni­ties out­side of hos­pi­tals. From such al­ter­na­tives as ur­gent care, tele­health and concierge medicine to fed­er­ally qual­i­fied com­mu­nity health cen­ters and con­sult­ing, the ex­pan­sion of the job mar­ket has made it harder for health sys­tems and hos­pi­tals to hold onto their clin­i­cal staff be­yond a few years.

As with most other pro­fes­sions, the av­er­age ten­ure of a health­care pro­fes­sion­als at one job has been de­clin­ing in re­cent years, stand­ing at 5.6 years in 2016 for hos­pi­tal work­ers, ac­cord­ing to the U.S. Bureau of La­bor Statis­tics, com­pared to six years in 2012. Non­hos­pi­tal health­care work­ers had an av­er­age ten­ure of just 3.4 years in 2016, down from 3.9 years in 2014.

Sin­gle­ton said those statis­tics high­light the need for providers to learn how to cre­ate the kind of work­force cul­ture that in­spires a high level of en­gage­ment from their em­ploy­ees to keep turnover rates low. Among providers and in­sur­ers on this year’s Best Places to Work in Health­care list, 92% of em­ploy­ees said they planned to stay with their em­ployer for at least two years; 90% of em­ploy­ees at sup­pli­ers and ven­dors were com­mit­ted to con­tin­u­ing with their firms.

A new cul­ture

The com­pe­ti­tion to re­cruit tal­ented health­care pro­fes­sion­als in Texas has been an in­creas­ingly tough propo­si­tion in re­cent years as ex­pan­sion has led to the state hav­ing the most hos­pi­tals in the U.S.—more than 370.

For providers like Texas Health Pres­by­te­rian Hos­pi­tal Flower Mound, the abil­ity to re­tain its staff has helped the hos­pi­tal to gar­ner a rep­u­ta­tion as an at­trac­tive place to work among can­di­dates when new po­si­tions be­come avail­able. Flower Mound has re­duced its an­nual turnover rate from 50% when it be­gan op­er­a­tions in 2010 to 4% two years later and has main­tained a rate within the sin­gle dig­its for the past seven years.

The hos­pi­tal gar­nered the top spot on this year’s Best Places to Work list among providers and in­sur­ers.

“We have lit­tle need to uti­lize huge com­pa­nies to place our po­si­tions be­cause we re­ally staff from word of mouth,”

said Ni­cole Sch­weigert, hu­man re­sources di­rec­tor at Flower Mound, which is a part of Ar­ling­ton-based Texas Health Re­sources. Sch­weigert felt a big part of Flower Mound’s ap­peal has been the cul­ture of open­ness and com­mu­nity the sys­tem has de­vel­oped be­tween man­age­ment and staff.

“We found that the bet­ter we treated our em­ploy­ees, the bet­ter pa­tient care they de­liv­ered,” Sch­weigert said.

Part of the ef­fort to­ward treat­ing their em­ploy­ees bet­ter has in­cluded em­pha­siz­ing the im­por­tance of pro­vid­ing a healthy work-life bal­ance. Flower Mound of­fers flex­i­ble work sched­ules and re­wards em­ploy­ees with a gain-shar­ing pro­gram for meet­ing cer­tain qual­ity im­prove­ment mea­sures. It also of­fers re­wards for em­ploy­ees that pro­vide in­no­va­tive ideas to­ward im­prov­ing hos­pi­tal per­for­mance.

Every quar­ter the hos­pi­tal’s CEO has open fo­rums with staff where he ex­plains the or­ga­ni­za­tion’s fi­nan­cial sta­tus and dis­cusses whether the hos­pi­tal is meet­ing its care de­liv­ery per­for­mance goals. It’s an en­vi­ron­ment that stresses trans­parency be­tween the lead­er­ship and staff, which Sch­weigert said has trans­lated into high em­ployee sat­is­fac­tion rat­ings and an av­er­age ten­ure of 5½ to seven years.

“We’ve had peo­ple leave and come right back,” Sch­weigert said.

The ef­fort among health­care providers like Flower Mound to find and hold onto ca­pa­ble work­ers is based on cre­at­ing an en­vi­ron­ment where hir­ing the right em­ployee is not just a mat­ter of an­swer­ing whether they can do the job ef­fec­tively but rather if they can fit well within the cul­ture.

Other or­ga­ni­za­tions have be­gun to take that re­cruit­ment strat­egy a step fur­ther.

Health­care re­cruit­ing ex­pert Peter Burke—pres­i­dent and co-founder of Best Com­pa­nies Group, which con­ducts the Best Places to Work survey for Mod­ern Health­care—said com­pa­nies can cre­ate their own “fun­nels” through outreach pro­grams that gen­er­ate in­ter­est among can­di­dates while they’re still in school.

He said such ini­tia­tives are an ex­am­ple of how health­care or­ga­ni­za­tions are try­ing to de­velop the kind of brand­ing strate­gies that have made com­pa­nies like Ap­ple and Google house­hold names.

“They’re cre­at­ing a rep­u­ta­tion for them­selves,” Burke said. “For years, we’ve all been fo­cused on mar­ket­ing our prod­ucts and ser­vices, and now there’s al­most as much fo­cus on mar­ket­ing your­self as an em­ployer—so the em­ployer brand has be­come a fo­cus and a real ef­fort—and it’s pay­ing off.”